Respiratory Flashcards
obstructive and restrictive FEV FVC patterns
Obsrtuctive: ↓ FEV
restrictive: ↓FVC
type of hypersensitivity reaction atopic asthma
type 1 hypersensitivity
eg leukotreine receptor antagonist
montelukast
alpha antitrypsin defiiency associated with which disease
emphysema
chromosome 14
red puffers= ??
blue bloaters = ??
red puffers= emphysema
blue bloaters= bronchitis
what would ABG show on blue bloater
type 2 resp failure, are INSENSITIVE to co2
Ix for COPD
post bronchodilator spirometry and assess severity
spirometry 9obstructve or restrictive pattern with bronchiectasis
obstructive
type of inheritance CF
AUTO recessive 1/2500
ghon focus
primary infection of TB in lung
TB associated with which derm condition
erythema nodosum
Ix suspected TB
sputum samples- microscopu, PCR, culture
bronchoscopy with biopsy
CXR- shows upper lobe cavitation, pleural effusion, bilat hilar lymphadenopathy
how to investigate latent TB
Mantoux test
what drug causes lower zone lung fibrosis
amiodarone , methotrexate
sarcoidosis
who does it afffect
signs and symptoms
serum XXX?= positive
affects young ppl african descent
hypercalcaemia
bil hilar shadowing
sob, malaise, weight loss
erythema nodosum
SERUM ACE is raised
chemicals associated with occupational asthma:
isocyanates
platinum salts
soldering flux resin
glutaraldehyde
flour
epoxy resins
proteolytic enzymes
GF PEPSI
what can rapid aspiration/drainage of pneumothorax cause later on (same admission)
re expansion pulmonary oedea
what can rapid aspiration/drainage of pneumothorax cause later on (same admission)
re expansion pulmonary oedema
how does hypocapnia affedt oxygen dissocation curve
Shifts the oxygen dissociation curve to the left
low co2 shifts LEFT
what would shift the oxygen dissociation curve to the left?
Left - Lower oxygen delivery - Lower acidity, temp, 2-3 DPG - also HbF, carboxy/methaemoglobin
SHIFT LEFT- EVERYTHING LOWER
SHIFT RIGHT- EVERYTHING RAISED
SMOKING cessation
types of treatment
NRT
varenicline=
buproprion
DO NOT TAKE MORE THAN ONE AT A TIME
Nicotine replacement therapy SIDE EFFECTS
nausea & vomiting, headaches and flu-like symptoms
Varenicline side effects and MOA
a nicotinic receptor partial agonist
top SE- nausea
headache, insomnia, abnormal dreams
avoid in depressed pts self harm risk
which more common- NSCLC or SCLC
NSCLC
SCC , adenocarcinoma, large cell anaplastic tumour
SCCs arise from what type epithelium
normal pseudostratified ciliated columnar epithelium
recurrent laryngeal nerve palsy symptoms
hoarse / change in voice,
pancoast syndrome
horners, shoulder pain, oedema, hand arm atrophy
eg of restrictive lung disease
sarcoidoisis, pulmonary fibrosis, obesity
ground glass CXR
idiopathic pulmonary fibrosis= restrictive
how is FVC, TLCO affected in restrictive lung disease
red FVC
reduced TLCO (impaired gas exchange)
gold standard Ix IPF
ct
which type hypersensitivity reaction in extrinsic allergic alveolitis
type 3 hypersensitivity reaction
common causative agents extrinsic allergic alveolitis
farmers lung- MICROPOLYSPORA
Bird fanciers lung- bird poo proteins
malt workers lung- ASPERGILLUS (fungus)
mushroom workers’ lung: thermophilic actinomycetes
onset timeline of extrinsic allergic alveolitis
4-6 afterrs post expousre symptom onset,
fever, myalgia
dry cough, SOB, possible wheeze
Tx extrinsic allergic alveolitis
o2, oral prednisolone
Ix extrinsic allergic alveolitis
CXR- upper zone fibrosis
bronchoalveolar lavage= lymphocytosis
serological assays= IgG antibodies
blood test= NO EOSINOPHILIA
inhalation coal dust causes– ?
pneumoconiosis
how does asbestos affect lung
Asbestos can cause a variety of lung disease from benign pleural plaques to mesothelioma.
benign asbestos lung
pleural plaques
what are pleural plaques
timeline
benign, do NOT undergo malignant change
most common form of asbestos lung
NON progressive
what is asbestosis caused by
what is it
timeline
HEAVY exposure to asbestos
10 years post exposure
affects lower lung fibrosis
mesothelioma cause
caused by light exposure to asbestos
20-40 years post exposure
pleuritic chest pain
unilateral pleural effusion on cxr
X infection is an important CF-specific contraindication to lung transplantation
Chronic infection with Burkholderia cepacia
(CFTR) gene which chromosome
chromosome 7
HLA associations:
HLA-DR1: bronchiectasis
HLA-DR2: systemic lupus erythematous (SLE)
HLA-DR3: autoimmune hepatitis, primary Sjogren syndrome, type 1 diabetes Mellitus, SLE
HLA-DR4: rheumatoid arthritis, type 1 diabetes Mellitus
HLA-B27: ankylosing spondylitis, postgonococcal arthritis, acute anterior uveitis
Pulmonary arterial hypertension is defined as an elevated pulmonary arterial pressure of greater than ??? after rest AND exercise
25mmHg at rest or 30mmHg after exercise
typical treatment for sarcoidoisis
nothing, resolves in maj of people
indications for starting steroid therapy for sarcoidoisis
Indications for corticosteroid treatment for sarcoidosis are:
- parenchymal lung disease
- uveitis
- hypercalcaemia
-neurological or cardiac involvement
most common organism causing copd exacerbations
h influenzae
asbestos fibrosis zone
lower zone
methotrexate lower or upper zone fibrosis
lower zone
most common organism bronchiectasis
h influenzae
egg shell calcification on cxr =?
silicosis
Buproprion MOA
norepinephrine and dopamine reuptake inhibitor, ANDnicotinic antagonist
Pneumothorax- what is primary and secondary
Primary: A primary pneumothorax is considered the one that occurs without an apparent cause and in the absence of significant lung disease
secondary- if existing lung pathology
Pneumothorax primary management
If rim of air is < 2cm + patient is NOT SOB then discharge
Aspiration should be attempted
if aspiration fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted
Secondary pneumothorax management
> 50 years old and the rim of air is > 2cm and/or the patient is short of breath then a chest drain
aspiration if the rim of air between 1-2cm.
If aspiration fails (i.e. pneumothorax is still greater then 1cm) a chest drain should be inserted. All patients should be admitted for at least 24 hours
if the pneumothorax is less the 1cm then the BTS guidelines suggest giving oxygen and admitting for 24 hours
what organism causes farmers lung
farmers lung is a type of EEA
caused by:
Saccharopolyspora rectivirgula
Bilateral hilar lymphadenopathy causes
B/l hilat lymphadenopathy- something Round comes to yr mind right? Well then Its easy, the causes are, tuber(round); circloidosis,BERRYlliosis,cocciodosos( too may half and full cirlces in the name),then round mass lymphoma
Allergic bronchopulmonary aspergillosis
cause
CFs
and management
allergy to Aspergillus spores
CFs
asthma
Proximal bronchiectasis
Blood eosinophilia
Immediate skin reactivity to Aspergillus antigen
Increased serum IgE (>1000 IU/ml)
Mx= oral prednisolone
Expiratory reserve volume + Residual volume=????
= functional residual capacity
what is Tidal volume (TV)
volume inspired or expired with each breath at rest
500ml in males, 350ml in females
Inspiratory reserve volume (IRV) = 2-3 L
maximum volume of air that can be inspired at the end of a normal tidal inspiration
inspiratory capacity = TV + IRV
Expiratory reserve volume (ERV) = 750ml
maximum volume of air that can be expired at the end of a normal tidal expiration
Residual volume (RV) = 1.2L
volume of air remaining after maximal expiration
increases with age
RV = FRC - ERV
Functional residual capacity (FRC)
the volume in the lungs at the end-expiratory position
FRC = ERV + RV
Vital capacity (VC) = 5L
maximum volume of air that can be expired after a maximal inspiration
4,500ml in males, 3,500 mls in females
decreases with age
VC = inspiratory capacity + ERV
what is lights criteria used for and what is it:
determine if pleural fluid is transudate or exudate
EXUDATE:
protein 30>
TRANSUDATE
protein <30
Lights criteria used when protein levels between 25-30
EXUDATE LIKELY if at least one of:
-pleural fluid protein divided by serum protein >0.5
- pleural fluid LDH divided by serum LDH >0.6
- pleural fluid LDH more than two-thirds the upper limits of normal serum LDH
pleural plaques management
no need to follow up- benign
upper zone lung fibrosis causes + acronym
CHARTS- upper zone fibrosis
C - Coal worker’s pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis
ABG on hyperventilation pt
resp alkalosis
all c02 blown off
Alpha-1 antitrypsin: PiMZ =
carrier and unlikely to develop emphysema if a non-smoker
Alpha-1 antitrypsin (A1AT) deficiency is a common inherited condition caused by a lack of?????
of a protease inhibitor (Pi) normally produced by the liver.
alleles classified by their electrophoretic mobility - M for normal, S for slow, and Z
alphabetical
What is the most appropriate test prior to starting azithromycin?
Before starting azithromycin do an ECG (to rule out prolonged QT interval) and baseline liver function tests
diagnostic investigation OSA
Polysomnography is diagnostic for obstructive sleep apnoea
INITIAL settings for bipap in copd
IPAP = 10 cm H2O; EPAP = 5 cm H2O
Chlamydia psittaci is treated with ?
tetracycline
eg doxy
chlamydia psittaci= bird fancier lung
alcoholic+SOB+ cavitating lesion on CXR=?
klebsiella
CRITERIA FOR ARDS
-acute onset (within 1 week of a known risk factor)
-pulmonary oedema: bilateral infiltrates on chest x-ray (‘not fully explained by effusions, lobar/lung collapse or nodules)
-non-cardiogenic (pulmonary artery wedge pressure needed if doubt)
-pO2/FiO2 < 40kPa (300 mmHg)
when to use NIV in COPD
T2RF=
high pCO2
a respiratory acidosis (PaCO2>6kPa, pH <7.35 ≥7.26)
BTS guidelines asthma and NIV?
NOT to NIV in asthmatics
churg strauss syndrome/Eosinophilic granulomatosis with polyangiitis
CFs
Tx
asthma, eosinophilia, presence of mono-/polyneuropathy, flitting pulmonary infiltrates, paranasal sinus abnormalities and histological evidence of extravascular eosinophils.
pANCA positive
LTRAs may precipitate churg strauss
best lung func investigation for upper airway compression?
flow volume loop
SCC lung + high calcium and low phosphate?=?
PTHrP is a paraneoplastic syndrome associated with squamous cell lung cancer
Secretion of parathyroid hormone related peptide (PTHrP)
what does alpha antitrypsin do in the body
protease inhibitor
what is lofgrens syndrome
Lofgren’s syndrome is an acute form sarcoidosis characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia.
high altitude pulmonary oedema (HAPE)Mx
decent of altitude
o2
nifedipine
cryptogenic organising pneumonia.
long symptom weeks to month not respond to antibiotics , respiratory crackles on examination .
not assd with smoking
Bloods show a leukocytosis and an elevated ESR and CRP. Imaging typically shows bilateral patchy or diffuse consolidative or ground glass opacities. Lung function tests are most commonly restrictive but can be obstructive or normal. The transfer factor is reduced.
No tx unless severe= high dose oral steroids
4 stages of sarcoidosis on CXR
- bil Hilar lymphadenopathy
- bil Hilar lymphadenopathy +infiltrates
- infiltrates
- fibrosis
what med can be used to prevent acute mountain sickness
acetazolomide carbonic anhydrase inhibitor
pneumonia in bird keeper: bacteria
Chlamydia psittaci
+ conjnctivities
factors assd with poor prognosis of sarcoidosis
-insidious onset, symptoms > 6 months
-absence of erythema nodosum
-extrapulmonary manifestations: e.g. lupus pernio, splenomegaly
- CXR: stage III-IV features
- black people
in sarcoidoisis, why hypercalcaemia
increased activation of vit d
what type of surgery can be done in alpha anti trypsin def
lung vol reduction surgery
Causes of a raised TLCO
asthma
pulmonary haemorrhage (Wegener’s, Goodpasture’s)
left-to-right cardiac shunts
polycythaemia
hyperkinetic states
male gender, exercise
Causes of a lower TLCO
pulmonary fibrosis
pneumonia
pulmonary emboli
pulmonary oedema
emphysema
anaemia
low cardiac output
which type of lung ca most likely to cause cavitating lesions
Squamous celll
Ix in adults with suspected asthma
>17yo
Adults with suspected asthma should have both a FeNO test and spirometry with reversibility
triangle of safety for chest drain borders
base of the axilla
lateral edge pec major
5th intercostal space
anterior border of latissimus dorsi
bipap and cpap both NIV- when to use either
bipap- severe COPD, t2rf
cpap- in t1rf eg pulm oedema, covid pneumonitis, OSA
Heerfordt syndrome
Heerfordt syndrome is a subset of sarcoidosis: a combination of parotid enlargement, fever, and anterior uveitis.
Chest x-ray: parenchymal infiltrates with tram track opacities and ring shadows.
Oral glucocorticoids are the treatment of choice for allergic bronchopulmonary aspergillosis
increase transfer factor (4)
raised: asthma, haemorrhage, left-to-right shunts, polycythaemia
lower transfer factor = everything else
exposure to WHAT is a risk factor for TB
Silica
when to give LT oxygen tehrapy in copd abg
ABG 2 measurements of pO2 < 7.3 kPa
sarcoidosis CXR stages
Sarcoidosis CXR
1 = BHL
2 = BHL + infiltrates
3 = infiltrates
4 = fibrosis
cherry red lesion in lung bronchus= ?
lung carcinoid
most common and likely vessel to bleed during haemoptysis
bronchial artery
WHEN TO use LTOT in COPD
2 ABG readings Po2< 7.3
DVT PE managemnt times with DOAC
provoked DVT/PE= 3 months DOAC
active cancer and confir,ed dvt/pe = 6 months
